Provider Demographics
NPI:1467831453
Name:MOODY, JAIME LYNN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:LYNN
Last Name:MOODY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-9998
Mailing Address - Country:US
Mailing Address - Phone:908-454-7553
Mailing Address - Fax:908-454-8031
Practice Address - Street 1:1207 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-4100
Practice Address - Country:US
Practice Address - Phone:908-454-7553
Practice Address - Fax:908-454-8031
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03238800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist